The future of Arkansas' "private option" insurance plan for the poor is far from settled.
Gov. Asa Hutchinson last week did show some greater support for the program, which uses federal Medicaid expansion dollars to buy private insurance for those who qualify.
But he conditioned his backing for the program's continuation, saying the state needs more flexibility to limit its reach. The federal government will have to approve any such changes.
So, that's one problem. Whatever the state might ask must have federal approval, which may or may not be forthcoming.
Granted, Arkansas had to get federal endorsement for the private option plan as it now exists. Former Gov. Mike Beebe successfully negotiated that round of talks after state lawmakers came up with the private option.
The innovative approach was an alternative to the Medicaid expansion envisioned as part of the federal Affordable Care Act, or Obamacare, as it has been characterized.
So, what is it about the program that Hutchinson thinks must change?
There are numerous steps he said are necessary "to accomplish our objectives, reinforce our values and afford our future."
Business as usual, he said, "is not acceptable."
He can't ask for federal waivers, however, until he wins support in Arkansas.
The kinds of changes he's suggesting include requiring workforce training for some beneficiaries and establishing an income limit for the subsidized insurance program.
He also has the notion that the state might pay deductibles and copays for an employee's employer-provided health plan rather than have those working people enrolled in the private option.
Another idea is to have some people on the private option pay a portion of their premiums.
It's a fairly long list of suggested changes, most of which require federal approval and all of which need legislative buy-in.
Hutchinson acknowledged that reality last week as the governor addressed the Legislature's Joint Healthcare Task Force.
"As I make my presentation to you, I recognize that this is a legislative task force, that it's legislatively driven and that it's going to be a legislative solution."
The question then is how much influence does this governor have on the state Legislature with its increasingly conservative perspective.
Hutchinson is a bona fide conservative himself, just not quite so right-leaning as some of the state's hard-right lawmakers.
He's trying to walk a line that satisfies that farther-right contingent and still holds Democratic support for a revamped private option.
You'll remember lawmakers renewed the program through December 2016, with the promise this task force would come up with some longer-term reform.
The private option has in recent years been renewed by the slimmest of legislative margins, which has led to a lot of heartburn for thousands of Arkansans who finally got healthcare coverage through the program.
This year, a "redetermination" of eligibility has further confused the situation for Medicaid recipients.
According to the governor, the private option had 250,000 enrollees at its peak but will be reduced after redetermination to maybe 220,000.
The state could choose, he said, to end the Medicaid expansion program, to take away that coverage for so many Arkansans and, consequently, to drain $1.4 billion to $1.7 billion federal dollars from the Arkansas economy.
He's not really for that approach.
The governor noted that uncompensated coverage clinics and hospitals previously provided has pretty much been dismantled, which would leave the private option beneficiaries with no coverage.
"We're a compassionate state and we're not going to leave 220,000 without some recourse, without some access to care," Hutchinson asserted, suggesting the state might have to absorb that coverage and pay for it from state revenue.
He's not really for that either.
Or, maybe the state would prefer to keep the federal government involved by continuing to take that Obamacare money.
Only, to win legislative support, Hutchinson suggested a number of tweaks to control costs and incentivize work yet still provide insurance coverage for needy Arkansans.
Don't get too wrapped up in the specific proposals. Even Hutchinson acknowledged that some of his ideas might be a bit premature, given that the task force hasn't gathered all the information it needs.
Still, he said, "Sometimes as governor you need to put some ideas out there to be shot at."
He expects some of the ideas to fail, others to succeed as the task force continues its work.
The primary goal is to pare down the future cost.
A recent consultant's study has suggested the total fiscal impact of Medicaid expansion in Arkansas will still be a net positive of $438 million between 2017 and 2021.
Those are the years in which Arkansas will have to pay a percentage of the cost of Medicaid expansion, 5 percent beginning in 2017 and 10 percent by 2020.
Nevertheless, Hutchinson wants to trim the overall costs of not just the expansion program but also of traditional Medicare and wants to Legislature to find those savings now.
Brenda Blagg is a freelance columnist and longtime journalist in Northwest Arkansas. Email her at [email protected].
Commentary on 08/26/2015